作为食管替代物的去神经全胃24小时腔内pH值和胆汁联合监测

Combined 24-hour intraluminal pH and bile monitoring of the denervated whole stomach as an esophageal substitute.

作者信息

Romagnoli R, Bechi P, Salizzoni M, Collard J M

机构信息

Department of Surgery, Louvain Medical School Hospital, Brussels, Belgium.

出版信息

Hepatogastroenterology. 1999 Jan-Feb;46(25):86-91.

PMID:10228769

Abstract

BACKGROUND/AIMS: The study aims to evaluate the pH and the presence of bile in the denervated whole stomach pulled up to the neck after subtotal esophagectomy.

METHODOLOGY

The pH and the presence of bile in the gastric cavity were monitored by combined 24-hour pH and bilimetry in 16 patients having their whole stomach as an esophageal substitute (i.e., 8 with and 8 without a gastric drainage procedure) and in 25 healthy control subjects. The percentage of time during which pH was < 2 as well as the percentage of time during which bile absorbance was > 0.25 for the total, upright, and supine periods of recording were considered for each subject studied. Seven patients underwent a gastroscopy with biopsies.

RESULTS

Intragastric acidity was normal in 50% of patients while it was reduced in the other 50%. Ten of the 16 patients (62.5%), i.e., 4 with (50%) and 6 without (75%) a drainage procedure, had excessive exposure of the gastric mucosa to bile. No significant correlation was found between the existence of a high intraluminal pH profile and excessive bile exposure (p = 0.9163). Bile exposure was significantly higher in whole stomach patients than in controls in both the upright and supine positions, irrespective of the existence or absence of a drainage procedure (p ranging from 0.0272-0.0001). Bile exposure in the supine position tended to be longer in patients without than in those with a drainage procedure (p = 0.0929). Helicobacter pylori-negative chemical gastritis was present in 3 of the 7 patients who underwent a gastroscopy, all 3 having excessive bile exposure and no food retention in the transplant lumen.

CONCLUSIONS

Gastric denervation and transposition up to the neck increased exposure of the gastric mucosa to bile, irrespective of the patient's position and of the presence of a gastric drainage procedure. The absence of gastric drainage procedure tends to ensure exposure to bile prolongeLow gastric acidity, if present, is due to a reduction in acid secretion rather than to a buffering effect from duodenal juice having refluxed. Gastritis is more likely to be related to excessive exposure of the gastric mucosa to bile than to food retention.

摘要

背景/目的：本研究旨在评估食管次全切除术后上提到颈部的去神经全胃的pH值及胆汁的存在情况。

方法

通过联合24小时pH监测和胆汁测定法，对16例将全胃用作食管替代物的患者（即8例行胃引流术和8例未行胃引流术）以及25例健康对照者的胃腔内pH值和胆汁存在情况进行监测。记录每位研究对象在总记录期、直立期和仰卧期pH值<2的时间百分比以及胆汁吸光度>0.25的时间百分比。7例患者接受了胃镜检查并取了活检。

结果

50%的患者胃内酸度正常，而另外50%的患者胃内酸度降低。16例患者中有10例（62.5%），即4例行引流术者（50%）和6例未行引流术者（75%），胃黏膜过度暴露于胆汁。胃腔内高pH值与胆汁过度暴露之间未发现显著相关性（p = 0.9163）。无论是否行引流术，全胃患者在直立位和仰卧位时胆汁暴露均显著高于对照组（p值范围为0.0272 - 0.0001）。未行引流术的患者仰卧位时胆汁暴露时间往往比行引流术的患者更长（p = 0.0929）。7例接受胃镜检查的患者中有3例存在幽门螺杆菌阴性的化学性胃炎，这3例患者均有胆汁过度暴露且移植胃腔内无食物潴留。